Provider Demographics
NPI:1053307249
Name:NELSON, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SHADY AVE
Mailing Address - Street 2:D-108
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4460
Mailing Address - Country:US
Mailing Address - Phone:412-661-9008
Mailing Address - Fax:412-661-1055
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:D-108
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4460
Practice Address - Country:US
Practice Address - Phone:412-661-9008
Practice Address - Fax:412-661-1055
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028096E2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAN197917OtherHIGHMARK BC/BS
PAN197917OtherHIGHMARK BC/BS
PA197917Medicare ID - Type Unspecified
PAN197917OtherHIGHMARK BC/BS